Have you been told that you are at risk for limb amputation?
You have options — and the Amputation Prevention Center at Valley Presbyterian Hospital is here to help restore your health and quality of life.
At the Amputation Prevention Center at Valley Presbyterian Hospital, we believe limb preservation begins with early intervention and customized patient education.
Here today is Dr. Eric Espensen, he is the Co-Director of the Amputation Prevention Center at Valley Pres.
It's one of few clinics in the US that is dedicated to preventing complications that threaten amputation, primarily of lower limbs.
They focus on the complications of diabetes, and it's a team of podiatrists, vascular surgeons and wound-care specialists.
Selected Podcast
Avoiding Complications from Diabetes
Featured Speaker:
Dr. Espensen earned his Doctor of Podiatric Medicine degree from The Ohio College of Podiatric Medicine in Cleveland. He completed his residency in foot and ankle surgery at the Southern Arizona VA Health Care System, in the Podiatry Division of the Department of Surgery, in Tucson, Ariz. He also completed specialty training in the diabetic foot under the tutelage of David G. Armstrong, a widely known podiatric surgeon, researcher and amputation prevention expert.
Dr. Espensen participates as an article reviewer and contributing editor at several leading medical journals, has been published in numerous research papers, and featured in the press for his specialty. He was voted “Best Podiatrist in Burbank” by the city of Burbank in 2012 and 2013.
Eric Espensen, MD
Dr. Espensen is board-certified by the American Board of Multiple Specialties in Podiatry in Foot & Ankle Surgery and Podiatric Medicine. Most recently, Dr. Espensen was the Chief of Podiatry at Providence St. Joseph Medical Center in Burbank. He also is a biomedical consultant for Century City Hospital.Dr. Espensen earned his Doctor of Podiatric Medicine degree from The Ohio College of Podiatric Medicine in Cleveland. He completed his residency in foot and ankle surgery at the Southern Arizona VA Health Care System, in the Podiatry Division of the Department of Surgery, in Tucson, Ariz. He also completed specialty training in the diabetic foot under the tutelage of David G. Armstrong, a widely known podiatric surgeon, researcher and amputation prevention expert.
Dr. Espensen participates as an article reviewer and contributing editor at several leading medical journals, has been published in numerous research papers, and featured in the press for his specialty. He was voted “Best Podiatrist in Burbank” by the city of Burbank in 2012 and 2013.
Transcription:
Avoiding Complications from Diabetes
Melanie Cole (Host): Have you been told that you’re at risk for limb amputation? You have options, and the Amputation Prevention Center at Valley Presbyterian Hospital is here to help you restore your health and the quality of life. At the Amputation Prevention Center at Valley Presbyterian Hospital, we believe limb preservation begins with early intervention and customized patient education. My guest today is Dr. Eric Espensen. He’s the co-director of the Amputation Prevention Center at Valley Presbyterian Hospital. It’s one of the few clinics in the U.S. that is dedicated to preventing complications that threaten amputation, primarily of the lower limbs. Welcome to the show, Dr. E. Tell us a little bit about diabetes and amputation, and why are they connected? Why are diabetic patients at risk for amputation?
Dr. Eric Espensen (Guest): Well, thank you for having me. Diabetes is an extremely common problem. More than 26 million diagnosed cases in the United States with almost 400 million diabetic people worldwide. This is a growing epidemic. Every year that count is going higher. The most problems that diabetic patients have are known complications including loss of vision, cardiovascular problems, heart problems, and many diabetic patients develop sores on their feet that do not heal. Many of these patients are unaware, so this is a common issue that we see, and we have a clinic that routinely handles patients to help heal these wounds and prevent them from coming back.
Melanie: What can a typical diabetic patient do to take better care of themselves so that possibly they don’t suffer from some of these side effects?
Dr. Espensen: Well, we have a list of three top things that every diabetic patient should do every day. Number one is work on that blood sugar. Follow your diet. Stay healthy. Eat well. Listen to Melanie and her diet tips to help keep that glycemic index down. Watch that blood sugar. Number two, every patient should have a good relationship with their primary doctor and the doctor who cares for their diabetes. Work closely with them to do the best that you can. Diabetes is a lot like a wildfire, and once it gets out of control, it does a lot of damage. But when contained, it can be contained very effectively and help limit these problems. Number three, I urge every diabetic patient every day, take 20 seconds and take a look at their feet, between their toes and on their legs, and just make sure that there’s no bruises or sores that they oftentimes won’t feel. But if they see them, then they’re aware, then they contact their doctor and get over to the right person as soon as possible.
Melanie: What are they looking for, Dr. E, when they are checking their feet? You said bruises and sores and look all around what, between the toes, under the feet, around the ankles, feeling for these things, looking around?
Dr. Espensen: Well, number one is looking. Use your eyes. And if you’re not flexible, get a small hand mirror to look at the bottom of your feet, the sides of the feet. The reason I stress this is one of the biggest complications of diabetes is nerve damage. Many of these patients develop loss of sensation of their feet and, sometimes, their hands. This is very similar to say when you or I have a foot fall asleep and you can’t feel it, well, these patients lose sensation to their hands and feet, and oftentimes they’ll walk around and step on something small, something sharp, and develop a small bruise, blister, sore, or cut that you or I would feel because we have good, strong nerves. But these patients don’t feel it and are oftentimes unaware, and these small nicks and cuts become infected, become large sores, and many times patients are completely unaware that they have a large sore on their foot or ankle.
Melanie: Is there any treatment for that neuropathy you’re discussing?
Dr. Espensen: Well, that’s a continuing field and there’s a lot of new research coming down about how to help slow the loss of sensation and how to help regain a little… now, there’s not a lot of success yet, but the number one key hand in hand, good diabetes care, watching those sugars, translates to a lot less loss of sensation, staying healthier longer. So I urge my patients that before the problem starts, cut it off. Take good care of yourself. Take your medications. Watch your blood sugar. And that really helps limit it. There are some newer treatments and studies right now that I can’t go into because it’s still in the clinical phase, but there’s a lot of promising research in this field to try to help restore the nerve sensation for a lot of these patients.
Melanie: What do you do to help heal those foot ulcers as they do crop up? Are there topical solutions? What are the treatments?
Dr. Espensen: Well, we have a whole spectrum of treatments, including stuff to put on the wound, ointments, creams, medicines. We have some of the newest cutting-edge gauze and topical treatments including foams and sponges and very interesting scientific materials that help boost the rate of healing. The other factor is try to help prevent the patient from walking on the sores, including special shoes, boots, ways to keep them off the sore. Number three, making sure there’s no infection, or if there is one, get that treated as soon as possible and keep the family doctor in the loop. We spend a good amount of time on a daily basis calling the family doctor, working as a team so we can all work together and take the best care of these patients.
Melanie: With all the technology available today, Dr. E, what role does technology play in your practice of diagnosing and treating patients with complications of diabetes?
Dr. Espensen: Technology is a wonderful thing. In my 20 years, I have seen some great advances on the tissues that we’re using. One of the newest fields is stem cell research based where we’re using these new tissues. Now, we don’t harvest stem cells. That’s a lot of science fiction still. But we’re using stem cell derivative tissues and grafts that we can use to put on the wound to help grow skin at miraculous rates. When I first started, we didn’t have a lot of high-tech stuff, but as technology has improved, we have wonderful new machines, devices, techniques, and materials available to greatly increase the speed of healing. These patients can heal, get back to life, and we also have some great technologies to keep them healed so they don’t come back.
Melanie: Tell us a little bit about the Amputation Prevention Center and the team there for diabetic patients.
Dr. Espensen: Well, we’ve focused on assembling a team of a bunch of different types of doctors to make this one-stop shopping. We have a bunch of doctors who work specifically on feet, ankles, and legs to address the sores, take care of these wounds, and help heal. We have an excellent staff of nurses and techs who are specifically trained to work hand in hand with the doctor. We have several other physicians, including general surgeons, plastic surgeons to help with wounds above the waist, kind of out of my scope, but we all get involved in these wounds. We also have what’s called a vascular surgeon, or as I say, a glorified plumber. These doctors help these diabetic patients keep good blood flow to the feet and legs to help heal these wounds. We also have diabetic educators. We work very closely with our diabetes doctors or endocrinologists. They are part of our team. We try to cover all the bases so when a patient comes in, we don’t then send them out to all these different appointments. We try to do it all under one roof to make it as convenient as possible for the patient and for the doctors.
Melanie: Well, it sounds like a wonderful multidisciplinary approach. In just the last minute or so, give your best advice for those suffering from diabetes to avoid some of these complications that we’ve been discussing and what they should do while they’re going to the prevention center, things that you want them to know.
Dr. Espensen: Well, number one is nutrition. Many of our diabetic patients will ask me, “What should I be eating? What should I be doing?” This is when I love to involve one of our diabetic educators and nutritionists to help, because great nutrition is a key to getting healthy and staying healthy. Number two, I can’t stress enough, keep those blood sugars in check. The diabetes doctors are wonderful to help these patients really keep them firing on all eight cylinders staying healthy. Number three is working as closely as you can with your doctor to get these healed, help keep them healed. We have a rotating basis of patients who are well-healed who will pop back in for a checkup or a tune-up every couple of months so we can keep good tabs, and I really like that good relationship we have with these patients because we like to see you, but we’re much happier to keep you healed and keep you out living your life and not have to spend all your time in the doctor’s office.
Melanie: Thank you so much for that wonderful information. You are listening to VPH Med with Valley Presbyterian Hospital. For more information, you can go to valleypres.org. That’s valleypres.org. This is Melanie Cole. Thanks so much for listening.
Avoiding Complications from Diabetes
Melanie Cole (Host): Have you been told that you’re at risk for limb amputation? You have options, and the Amputation Prevention Center at Valley Presbyterian Hospital is here to help you restore your health and the quality of life. At the Amputation Prevention Center at Valley Presbyterian Hospital, we believe limb preservation begins with early intervention and customized patient education. My guest today is Dr. Eric Espensen. He’s the co-director of the Amputation Prevention Center at Valley Presbyterian Hospital. It’s one of the few clinics in the U.S. that is dedicated to preventing complications that threaten amputation, primarily of the lower limbs. Welcome to the show, Dr. E. Tell us a little bit about diabetes and amputation, and why are they connected? Why are diabetic patients at risk for amputation?
Dr. Eric Espensen (Guest): Well, thank you for having me. Diabetes is an extremely common problem. More than 26 million diagnosed cases in the United States with almost 400 million diabetic people worldwide. This is a growing epidemic. Every year that count is going higher. The most problems that diabetic patients have are known complications including loss of vision, cardiovascular problems, heart problems, and many diabetic patients develop sores on their feet that do not heal. Many of these patients are unaware, so this is a common issue that we see, and we have a clinic that routinely handles patients to help heal these wounds and prevent them from coming back.
Melanie: What can a typical diabetic patient do to take better care of themselves so that possibly they don’t suffer from some of these side effects?
Dr. Espensen: Well, we have a list of three top things that every diabetic patient should do every day. Number one is work on that blood sugar. Follow your diet. Stay healthy. Eat well. Listen to Melanie and her diet tips to help keep that glycemic index down. Watch that blood sugar. Number two, every patient should have a good relationship with their primary doctor and the doctor who cares for their diabetes. Work closely with them to do the best that you can. Diabetes is a lot like a wildfire, and once it gets out of control, it does a lot of damage. But when contained, it can be contained very effectively and help limit these problems. Number three, I urge every diabetic patient every day, take 20 seconds and take a look at their feet, between their toes and on their legs, and just make sure that there’s no bruises or sores that they oftentimes won’t feel. But if they see them, then they’re aware, then they contact their doctor and get over to the right person as soon as possible.
Melanie: What are they looking for, Dr. E, when they are checking their feet? You said bruises and sores and look all around what, between the toes, under the feet, around the ankles, feeling for these things, looking around?
Dr. Espensen: Well, number one is looking. Use your eyes. And if you’re not flexible, get a small hand mirror to look at the bottom of your feet, the sides of the feet. The reason I stress this is one of the biggest complications of diabetes is nerve damage. Many of these patients develop loss of sensation of their feet and, sometimes, their hands. This is very similar to say when you or I have a foot fall asleep and you can’t feel it, well, these patients lose sensation to their hands and feet, and oftentimes they’ll walk around and step on something small, something sharp, and develop a small bruise, blister, sore, or cut that you or I would feel because we have good, strong nerves. But these patients don’t feel it and are oftentimes unaware, and these small nicks and cuts become infected, become large sores, and many times patients are completely unaware that they have a large sore on their foot or ankle.
Melanie: Is there any treatment for that neuropathy you’re discussing?
Dr. Espensen: Well, that’s a continuing field and there’s a lot of new research coming down about how to help slow the loss of sensation and how to help regain a little… now, there’s not a lot of success yet, but the number one key hand in hand, good diabetes care, watching those sugars, translates to a lot less loss of sensation, staying healthier longer. So I urge my patients that before the problem starts, cut it off. Take good care of yourself. Take your medications. Watch your blood sugar. And that really helps limit it. There are some newer treatments and studies right now that I can’t go into because it’s still in the clinical phase, but there’s a lot of promising research in this field to try to help restore the nerve sensation for a lot of these patients.
Melanie: What do you do to help heal those foot ulcers as they do crop up? Are there topical solutions? What are the treatments?
Dr. Espensen: Well, we have a whole spectrum of treatments, including stuff to put on the wound, ointments, creams, medicines. We have some of the newest cutting-edge gauze and topical treatments including foams and sponges and very interesting scientific materials that help boost the rate of healing. The other factor is try to help prevent the patient from walking on the sores, including special shoes, boots, ways to keep them off the sore. Number three, making sure there’s no infection, or if there is one, get that treated as soon as possible and keep the family doctor in the loop. We spend a good amount of time on a daily basis calling the family doctor, working as a team so we can all work together and take the best care of these patients.
Melanie: With all the technology available today, Dr. E, what role does technology play in your practice of diagnosing and treating patients with complications of diabetes?
Dr. Espensen: Technology is a wonderful thing. In my 20 years, I have seen some great advances on the tissues that we’re using. One of the newest fields is stem cell research based where we’re using these new tissues. Now, we don’t harvest stem cells. That’s a lot of science fiction still. But we’re using stem cell derivative tissues and grafts that we can use to put on the wound to help grow skin at miraculous rates. When I first started, we didn’t have a lot of high-tech stuff, but as technology has improved, we have wonderful new machines, devices, techniques, and materials available to greatly increase the speed of healing. These patients can heal, get back to life, and we also have some great technologies to keep them healed so they don’t come back.
Melanie: Tell us a little bit about the Amputation Prevention Center and the team there for diabetic patients.
Dr. Espensen: Well, we’ve focused on assembling a team of a bunch of different types of doctors to make this one-stop shopping. We have a bunch of doctors who work specifically on feet, ankles, and legs to address the sores, take care of these wounds, and help heal. We have an excellent staff of nurses and techs who are specifically trained to work hand in hand with the doctor. We have several other physicians, including general surgeons, plastic surgeons to help with wounds above the waist, kind of out of my scope, but we all get involved in these wounds. We also have what’s called a vascular surgeon, or as I say, a glorified plumber. These doctors help these diabetic patients keep good blood flow to the feet and legs to help heal these wounds. We also have diabetic educators. We work very closely with our diabetes doctors or endocrinologists. They are part of our team. We try to cover all the bases so when a patient comes in, we don’t then send them out to all these different appointments. We try to do it all under one roof to make it as convenient as possible for the patient and for the doctors.
Melanie: Well, it sounds like a wonderful multidisciplinary approach. In just the last minute or so, give your best advice for those suffering from diabetes to avoid some of these complications that we’ve been discussing and what they should do while they’re going to the prevention center, things that you want them to know.
Dr. Espensen: Well, number one is nutrition. Many of our diabetic patients will ask me, “What should I be eating? What should I be doing?” This is when I love to involve one of our diabetic educators and nutritionists to help, because great nutrition is a key to getting healthy and staying healthy. Number two, I can’t stress enough, keep those blood sugars in check. The diabetes doctors are wonderful to help these patients really keep them firing on all eight cylinders staying healthy. Number three is working as closely as you can with your doctor to get these healed, help keep them healed. We have a rotating basis of patients who are well-healed who will pop back in for a checkup or a tune-up every couple of months so we can keep good tabs, and I really like that good relationship we have with these patients because we like to see you, but we’re much happier to keep you healed and keep you out living your life and not have to spend all your time in the doctor’s office.
Melanie: Thank you so much for that wonderful information. You are listening to VPH Med with Valley Presbyterian Hospital. For more information, you can go to valleypres.org. That’s valleypres.org. This is Melanie Cole. Thanks so much for listening.